title: An unusual presentation of a urethral diverticulum as a vaginal wall mass: a case report.
abstract: BACKGROUND
  The diagnosis of urethral diverticulum can be challenging given the vague or absent presenting symptoms. In addition, vaginal cancer can present with elusive symptoms--some parallel to urethral diverticula. A case of a bleeding ulcerated mass anticipated to be a vaginal cancer was instead identified as a benign urethral diverticulum. To the best of our knowledge, this is the first case report of a benign urethral diverticulum presenting as a bleeding, necrotic ulcerated mass.
  
  
  METHODS
  A 52 year-old multiparous African-American woman presented with a 2-day history of heavy vaginal bleeding passing large clots and suprapubic pain. A pelvic examination revealed blood clots in the vagina along with a friable, fibrous ulcerated lesion on the anterior suburethral vagina, just left of the midline measuring 4 × 2cm. Initially, this mass was considered to be a vaginal cancer. Intraoperative diagnosis of a benign urethral diverticulum was made.
  
  
  CONCLUSIONS
  The diagnosis of urethral diverticula based on the vast array of presenting symptoms, is difficult. This original case report may benefit both gynecologic oncologists and female pelvic surgeons and reconstructive surgeons to keep urethral diverticulum in the differential diagnosis when faced with a bleeding midline anterior vaginal mass. This unusual presentation of a urethral diverticulum demonstrates how similarly it may present to a vaginal cancerous mass.
authors.affiliation: Department of OB/GYN, University Hospitals Case Medical Center, Cleveland, OH 44106, USA. Megan.Billow@uhhospitals.org.
authors.forename: Megan
authors.initials: M
authors.lastname: Billow
authors.forename: Rebecca
authors.initials: R
authors.lastname: James
authors.forename: Kimberly
authors.initials: K
authors.lastname: Resnick
authors.forename: Adonis
authors.initials: A
authors.lastname: Hijaz